Treatment of intertrochanteric fractures in elderly high-risk patients: Dynamic hip screw vs. external fixation

Although the use of a dynamic hip screw (DHS) is considered to be the suitable treatment for intertrochanteric fractures، the external fixation device could produce clinical outcomes comparable to the outcomes obtained with conventional treatment. Furthermore، because external fixation is minimally invasive، we expected a lower rate of morbidity. Therefore، we compared the two treatments in a clinical trial of elderly patients with intertrochanteric fracture. Participants were included 60 elderly high-risk patients with an age of 785. 6 years who were treated for intertrochanteric fracture، resulting from a low energy trauma. Patients were randomly divided in two conditions regarding the treatment. In group A، the patients were treated with DHS، while in group B patients were treated with external fixator. The fixator was well accepted and no patient had significant difficulties while sitting or lying. The intraoperative time was 7310 minutes in group A and 158 minutes in group B (p<0. 01). 27 patients of group A needed blood transfusion postoperatively and none in group B (p<0. 001). The duration of hospitalization in group A and group B was 8. 42 and 2. 21. 5 days، respectively (p<0. 05). 9 of patients in group B had pin-track infection grade 2 that all were treated by oral antibiotics. There were no differences in comorbidities، quality of reduction، screw cut out، bed sore and HHS between the two groups. Treatment with external fixator is an effective treatment for intertrochanteric fractures in elderly high-risk patients. The advantages include quick and simple application، minimal blood loss، less radiation exposure، adequate fixation، pain reduction، and early discharge from hospital، low costs and favorable functional outcomes.